Polycystic Ovary Syndrome (PCOS)
What is PCOS?
Polycystic ovary syndrome (PCOS) is a complex hormonal imbalance disorder than is often accompanied by small cysts on the ovaries. It causes disruptions to fertility, as well as many other issues. PCOS is the most common endocrine disorder in women of reproductive age, affecting up to 18% of women. This is even higher in certain ethnic groups, such as Aboriginal women.
Normally, the ovaries produce female hormones (i.e., oestrogens and progesterone) and very low levels of the male hormone testosterone. In PCOS, however, testosterone is produced in excessive amounts, and progesterone, which is released after ovulation is produced erratically, or not at all.
What causes PCOS?
It is not clear what causes the hormone imbalance that defines PCOS.
Because many women who have been diagnosed with PCOS also have family members with it, it is believed that there may be a genetic component involved in the development of the hormone imbalance.
What are the signs and symptoms of PCOS?
The symptoms of PCOS may be mild at first, and the signs may vary from woman to woman. It is a complex disorder.
Most of the symptoms of PCOS are directly related to the elevated levels of circulating male hormones, resulting in issues such as:
- Sleep disorders, including sleep apnoea;
- Weight gain and trouble losing weight;
- Hirsuitism, in particular, extra hair on the face and body;
- Irregular periods, or no periods;
- Fertility problems; and
- Mood disorders, including depression and anxiety.
Women with PCOS may have irregular or no periods, and therefore ongoing issues with infertility. A lack of ovulation in women with PCOS results in continuous exposure of the endometrium (i.e. the uterine lining) to oestrogen, which can cause heavy, irregular bleeding due to excessive thickening of the endometrium.
Women with PCOS also have a higher than normal miscarriage rate if they do become pregnant.
Women with PCOS appear to be at increased risk of developing other health problems during their lives, including:
- Insulin resistance (if they don’t already have it as a result of genetic predisposition or weight management issues);
- Type 2 diabetes;
- Cholesterol abnormalities;
- Cardiovascular disease (i.e., heart disease, heart attacks and stroke); and
- Endometrial cancer (as a result of the continued exposure of the endometrium to oestrogen, and the lack of menstruation).
Diagnosis is made by a medical professional, through a detailed medical history and examination, ultrasound of the ovaries (noted to contain many cysts) and by measuring hormone levels.
A diagnosis of PCOS can be made when at least two out of three of the following criteria are met:
- The ovaries are polycystic on ultrasound, because:
- 12 or more follicles are visible on one ovary, or
- the size of one or both ovaries is increased.
- There are:
- high circulating levels of testosterone (and other androgenic hormones) in the blood, or
- symptoms experienced by the patient suggest an excess of testosterone (e.g., excess hair growth or acne).
- There is menstrual dysfunction such as:
- an absence of periods, or
- menstrual irregularity, or
- a lack of ovulation.
It is also important that your doctor rule out other possible causes of your symptoms, such as thyroid disease, or Cushing’s syndrome.
While PCOS is not curable, there are several approaches to achieving hormonal balance.
Treatment of PCOS depends primarily on the main problem or symptom you are concerned about. For example, if infertility is not a concern for you, the oral contraceptive pill can be prescribed to help reduce physical symptoms of acne and hirsuitism, and to help maintain regular periods. If fertility is your main goal, however, treatment with medication to combat insulin resistance, can lead to regular ovulation and a greater chance of pregnancy. Ovulation can also be stimulated with powerful fertility drugs. Sometimes IVF is offered to women with PCOS who want to conceive when other treatments have failed. Ovarian drilling or diathermy has also been used to treat women with PCOS, to induce ovulation in some women with PCOS, as an alternative to IVF.
Many women with PCOS have difficulty managing their weight, which can exacerbate physical symptoms. Diet and exercise to maintain or reduce weight has been shown to lower the risk of problems associated PCOS, such as diabetes. It may also improve the frequency of ovulation, improving fertility. In fact, several studies have shown that a weight loss of 6-10 kg is associated with a return of spontaneous ovulation in 90% of women. A separate study reported that a weight loss of 10 kg reduced miscarriage rate from 75% to 18% in some women with PCOS.
If you would like further guidance regarding your diet and PCOS, please contact us for an appointment.
Mental health issues such as depression and anxiety are experienced by almost half of the women diagnosed with PCOS. This may be due to the hormonal imbalance, or as a result of the symptoms such as hair growth, weight gain and acne. If you are experiencing any symptoms of depression or anxiety, it’s important to discuss your mood with your doctor. There are many treatment options available.